The population health management function plays a crucial role in the overall deployment of healthcare. Population health management helps to streamline processes, target health preventions and interventions and improve service quality and delivery. US HealthCenter Inc. is a 21 year old health risk management organization that provides services in all of the pre-disease, disease, and post-disease periods. The organization focuses on predicting future disease and its cost, and participation and rewards to prevent or manage disease. Its tools and services help assess health status, predict future costs, provide targeted health education, behavior improvement, disease management, pre-emptive intervention, and help manage employer-based onsite health services.
A Commitment to Wellness
US HealthCenter Inc. was founded by Raymond Gavery, MD, and engineer Gavin Quinnies in 2003. Doctor Gavery brought over 30 years of practicing preventive medicine, most notably as a pioneer in the concierge primary care field, creating one of the first direct primary care models. Quinnies was an early adopter of artificial intelligence and health risk management in the corporations he ran. He helped establish on site care and self-funding based on risk analysis in the early 90s.
The organization aims to improve people’s health and reduce healthcare costs by providing industry-leading health management science, technology, and advocacy to prevent and manage disease. Its core values are centered around the idea that everyone deserves good health, and it is dedicated to helping individuals and organizations discover ways to achieve optimal well-being. It intends to continue to be a leader in science technology and advocacy and aims to grow its business, particularly in areas that focus on managing health and risk. This approach has proven to enhance the quality of life for members. Additionally, it leads to better benefits, lower costs, and an improved member experience.
Expanding Healthcare Services Beyond AI
Initially, US HealthCenter Inc. focused primarily on delivering technology solutions, particularly artificial intelligence. However, the organization discovered that AI alone is just one necessary tool. As a result, it expanded its offerings and added services such as health testing, advocacy, and incentive management to its technology portfolio. In this process, US HealthCenter Inc. found immense value in building insurance solutions that leveraged the mentioned services into risk-based models that improved health and reduced costs.
The organization’s population health management program includes an incredible breadth and depth of industry-leading science, technology, and advocacy. Its AI-based health risk management assessment and analysis tools are among the few that can predict health conditions accurately. These tools determine the likelihood of a condition being diagnosed within the next three to five years with a high prediction rate. In 2015, this AI process was third-party validated by the Intel GE Care Innovations Validation Institute with a margin of accuracy between 80 and 93%. This ability to predict an individual’s future health conditions changes the conversation around their health improvement and disease management from reaction and management to prediction and prevention.
US HealthCenter Inc. refers to this method as helping the individual “find their way to their ‘why’”: discovering a purpose to work harder on improving and managing their health. This individual information is then aggregated and anonymized for the population’s risk-managing entity to understand future patterns of disease, diagnostic conditions, and potential costs. The organization termed this a potential cost “Risk Burden.” Its Risk Burden calculations have also been third-party validated by the Care Innovations Validation Institute to be an average accurate representation of future health costs annually within a margin of error of approximately 7%.
Risk Assessment and AI Approach to Health
To measure risk and improve health outcomes, US HealthCenter Inc.’s PredictiMed™ AI program combines various types of information. It includes family history and genetics, as well as demographic details like age, ethnicity, and biological gender. Additionally, it considers medical history and pharmaceutical history. PredictiMed™ AI also accounts for sleep, activity, nutrition, stress, biometric measures, and body chemistry data. This comprehensive approach helps determine the future risk of a specific disease for an individual.
The AI used to combine all these factors and their respective weightings was derived from hundreds of studies from dozens of sources that indicate what constitutes a risk for an individual. Tools and programs such as its medical claims Sweeper™ and the individual’s Personal Health Dashboard™, the NaviCare™ health management solution, and the HealthCounts™ incentive program are put to work to create population health management programs that work.
There are many versions of incentivizing individuals to participate in managing their health employed by the PredictiMed™ AI program. A program is typically developed with a series of actions designed to assess and reduce risk. When an individual participates in this program, their engagement can create targeted awareness. This awareness may, in itself, motivate the individual to improve their health. With over two decades of experience, the organization has discovered that when messaging is tailored towards a person’s “why” it resonates on a personal level, and people are far more likely to participate. Additionally, if you add rewards that are well-aligned, individuals find that additional reason to engage and get rewarded for doing so.
Predicting Health and Financial Impact
The organization can predict diseases that are emerging within a population. It assigns a Risk Burden value to these diseases, which creates a platform to measure risk reduction and return on investment. This capability distinguishes the organization from its competition. The analytics provided create a pathway for identifying targeted interventions that will generate a return. The organization focuses on the most expensive cases, which directly correlate to medical conditions that significantly impact quality of life. This focus is often overlooked in traditional predictive population health management approaches.
Achieving a return on investment is relatively straightforward. By removing or preventing high-cost claimants, the organization can positively impact stop loss, quality of life, productivity, and overall claims cost.
Through its health management programs, clients have received measurable outcomes. One example includes a three-year mitigation study on 4616 repeat participants and 24 unique clients. It experienced a 5.3% increase in optimal health categories (Excellent/Good) and an 8.9% decrease in the highest risk categories (Poor/Very Poor). Over 2000 individual cases were mitigated across 9 conditions, with a 24.3% improvement (reduction) of Significant Risk cases of Elevated, High, or Serious. This resulted in $16,036,808 or $7,982 per case of disease risk burden reduction.
Addressing Cost and Cultural Confusion in Healthcare
The biggest challenge faced by clients is the ever-increasing cost of healthcare, which continues to lower member benefits and reduce member satisfaction. One reason for this is the amount of disconnected point solutions that focus on a particular health concern or service factor. This does less and less for the member because of all the navigation required and increases the cost to the buyers and purveyors of healthcare, especially employers.
This continuous loop of new services that need to be communicated and connected ultimately is not utilized, creating cultural confusion for the members and the employers. USHC works hard to create a seamless member experience that puts all the services in the hands of the member, reduces cost, and allows for incentives and care navigation to be aligned around disease risk reduction and quality of life improvement.
Notable Recognitions
US HealthCenter Inc.’s Wholeistic™ approach to engaging members and populations at risk has received the highest honors in the industry. This approach addresses the health status of the whole person, not just the conditions the member has. In 2019, it achieved the highest Gold level of recognition for Care Navigation. This recognition highlights its capability to assist individuals and populations in moving from a state of high risk to a state of lower risk. In 2021 and 2022, its entire solution received great accolades in open competition recognition for population health providers. It achieved the Gold level from the Validation Institute’s categories of Population Health Management.
Integration of AI & Risk Burden
To track and analyze healthcare delivery patterns to understand cost exposure better, the organization uses AI-driven assessment that creates a benchmark, enabling it to measure patterns of successful prevention. US HealthCenter Inc. understands what it takes to measure, mitigate, and improve population health using the AI and Risk Burden processes.
The organization has been involved in the AI aspect of the industry for over 20 years and is well-positioned to continue that evolution. The idea of combining services under a single banner to deliver a seamless member experience and a succession of meaningful data that leads to intelligent decision-making is also something that it has a jump on and will continue to improve upon.
Advancements and New Launches in Products and Services
The organization is launching a new version of their Personal Health Dashboard™ or PHD. In 2003, this product was one of the very first health portals launched and has gone through several upgrades and iterations. This updated version will allow even greater engagement for the member in the palm of their hand. Furthermore, a new version of the care management program, NaviCare™, has been launched to nearly 20,000 healthcare providers with great success.
One area of significant growth continues to be in the insurance industry. Its latest health insurance product launch has grown from an idea to being adopted by some of the largest carriers and distribution partners in the country. The program is a truly unique health insurance program that rewards people for managing their health. Its cafeteria section 125 plans have expanded tremendously to reward people for managing and improving their health. Both of these insurance products significantly reduce the cost of healthcare from the very beginning because of the risk
management applied and the outcomes derived, all while providing the member superior and sometimes unmatched benefits.
US HealthCenter Inc. continues to revolutionize healthcare management by integrating advanced AI and risk assessment tools. The organization is committed to wellness, innovative services, and a holistic approach. It is setting new standards in the industry, enhancing health outcomes, and significantly reducing costs for individuals and organizations alike.
